Collateral impact of the COVID−19 pandemic on the use of healthcare resources among people with disabilities

How Austrian primary care physicians evaluated their available resources and quality of care during the first year of COVID-19: a repeated cross-sectional survey study

BACKGROUND

In March 2020, Austria was among the first European countries to declare a national lockdown, responding to SARS-CoV-2 infections with a stringent ringfencing policy for inpatient beds. These interventions altered access to the Austrian healthcare system. This study aims to understand demand- and supply-side factors influencing Austrian Primary Care Physicians' (PCPs') assessment of their care quality during the first ten months of the COVID-19 pandemic.

METHODS

The study deployed a cross-section design based on stratified random sampling, where all Austrian PCPs (split into three disjointed random samples) were invited to participate in an online questionnaire (in May, September and November 2020, respectively). A multinomial logit model was used to analyse the three sets of cross-sectional survey data. The study subjects are all 6,679 Austrian PCP (2020) with a registered practice. The total sample size was 403 (corresponding to a net response rate of 6.3%).

RESULTS

The primary outcome was the PCPs' evaluation of their care quality. Secondary outcomes were "patient behaviour and wellbeing" (five questions), with Cronbach's alpha of 0.74, and the PCPs' "pandemic preparedness" (five questions) with a smaller internal consistency (0.69). 47% of the PCPs rated their care quality during the first ten months of the pandemic as worse than before the outbreak of COVID-19. The overall assessment correlates to the pandemic stage, lack of preventive care and mediocre information exchange/cooperation within the medical profession. Towards the end of the first lockdown, PCPs' care quality perception was exclusively shaped by the availability of SARS-CoV-2 tests at the practice.

CONCLUSIONS

PCP quality assessments can serve as a real-time indicator, helping to anticipate the need for epidemiologic and diagnostic procedures. In Austria, supply-side factors, such as protective equipment and tests, were generally provided quickly by the public authorities. Findings suggest that perceptions of quality have changed considerably over time. Our results show that the understanding of quality changes during the first year. At the beginning, lack of resources or supply-side factors are the main driver for the assessment, while at the end of the first year, demand-side factors drive the quality assessment. In particular, the strong silo mentality and the separation between the care sectors have impacted the quality assessment of PCP.

Age-Stratified Risk of Severe COVID-19 for People With Disabilities in Korea: Nationwide Study Considering Disability Type

BACKGROUND

Understanding disparities in severe coronavirus disease 2019 (COVID-19) outcomes between people with disabilities (PwD) and people without disabilities (PwoD) is crucial, particularly when considering the heterogeneity within PwD and age differences. This study aimed to compare severe COVID-19 outcomes including deaths between PwD and PwoD with analyses stratified by age group and further examined by disability type.

METHODS

This retrospective, population-based cohort study used linked data from national COVID-19 cases and health insurance for individuals aged ≥ 19 years with COVID-19 from January 2020 to October 2022 in the Republic of Korea. Severe outcomes included severe cases and deaths, with logistic regression analysis of the risk disparities between PwD and PwoD based on age group and disability types. The subgroup analysis considered epidemic periods, accounting for the severe acute respiratory syndrome coronavirus 2 variant circulation.

RESULTS

The risk of severe COVID-19 outcomes and deaths among PwD varied by age and disability type. While severe outcomes were most prevalent in the older age groups for both PwD and PwoD, younger PwD faced a markedly higher risk-up to eightfold-compared to PwoD. The risk of disability status was greater than that of comorbidities in the 19-39 age group. Among disability types, individuals with internal organs-related and intellectual disabilities showed higher risk disparities with PwoD in severe outcomes than other types of disabilities. Throughout the pandemic, the disparity in death risk remained similar, with a slight increase in disparity during the omicron period for all severe outcomes in the age groups 19-39 and 40-64 years.

CONCLUSION

Prioritizing younger PwD, along with older age groups and people with comorbidities, is crucial in addressing public health crises. Risk-based prioritization is important to reduce overall risk. This includes prioritizing people with nternal organs-related and intellectural disabilities, who face higher health risks among PwD during a pandemic when resources are limited and time is of the essence.

The social evolution of COVID-19: pandemics as total social facts

The COVID-19 pandemic was an unprecedented global event in recent history. Beginning with an initial outbreak in Wuhan, China, in December 2019, the virus spread rapidly across the globe, causing millions of deaths and triggering an unprecedented health, economic, and social crisis. The initial response to the outbreak in many countries was the implementation of social distancing measures, including the closure of schools and businesses, the cancellation of mass events, and the banning of travel. These measures were aimed at reducing the virus' spread and preventing health systems from being overwhelmed by the numerous severe COVID-19 cases. However, these measures also had a devastating economic impact, especially on precarious workers and freelancers, as well as those who were unable to work from home. As the pandemic (also considered a syndemic or synergistic epidemic) dragged on, countries adopted more flexible approaches to dealing with the virus, adopting mitigation measures rather than social distancing measures. These included the use of masks, testing and contact tracing, and the opening of businesses and schools with the implementation of additional safety measures. This paper highlights the social consequences of the pandemic, ultimately arguing that it is a total social fact (from the French fait social total), based on Marcel Mauss' categorization, since it encompassed and impacted all facets of human life.

Influenza epidemiology and treatment in people with a visual disability: A retrospective cohort study

BACKGROUND

Visual disabilities (VD) are expected to rise with an aging population. Persons with VD experience a higher prevalence of chronic and acute diseases. Despite the significance of influenza to this population, there is limited data comparing influenza care disparities between those with VD and those without.

OBJECTIVE

The study aimed to determine the influenza burden and associated healthcare utilization in individuals with VD compared to those without disabilities.

METHODS

A retrospective cohort study was conducted using the Korean National Health Information Database, encompassing three influenza seasons (2011-2012 to 2013-2014). The influenza incidence and incidence rate ratio (IRR) was calculated. Adjusted IRRs were calculated using a zero-inflated Poisson model. We assessed the risk of admissions and 30-day post-influenza mortality, employing logistic regression or survival analysis.

RESULTS

A total of 504,374 patients (252,964 patients with VD and 251,410 controls) were followed for 1,471,480 person-years. The influenza incidence was higher in the VD cohort than in the control (8.8 vs. 7.8 cases per 1000 person-years). VD cohort had a higher influenza IRR (adjusted IRR 1·13, 95% confidence interval [CI] 1·02-1·25). Severe VD exhibited higher hospitalization risk (adjusted odds ratio [OR] 1·29, 95% CI 1·10-1·20) and increased medical costs. Severe VD was a significant risk factor for mortality (adjusted Hazard Ratio 1·89, 95% CI 1·04-3·45).

CONCLUSIONS

People with VD have a higher influenza incidence, while their outcomes are comparable to those without. Nevertheless, severe VD significantly contributes more to hospitalization, mortality, and medical costs than controls.

Impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low-and middle-income countries: a systematic review of the literature

Background

The COVID-19 pandemic has had a multifaceted impact on maternal and child services and adversely influenced pregnancy outcomes. This systematic review aims to determine the impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low- and middle-income countries.

Methods

The review was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A primary search of electronic databases was performed using a combination of search terms related to the following areas of interest: "impact' AND 'COVID-19' AND 'maternal and child health services' AND 'low- and middle-income countries. A narrative synthesis approach was used to analyse and integrate the results.

Results

Overall, 45 unique studies conducted across 28 low- and middle-income countries met the inclusion criteria for the review. The findings suggest the number of family planning visits, antenatal and postnatal care visits, consultations for sick children, paediatric emergency visits and child immunisation levels decreased compared to the pre-pandemic levels in the majority of included studies. An analytical framework including four main categories was developed based on the concepts that emerged from included studies: the anxiety of not knowing (1), overwhelmed healthcare systems (2), challenges perceived by healthcare professionals (3) and difficulties perceived by service users (4).

Conclusion

The COVID-19 pandemic disrupted family planning services, antenatal and postnatal care coverage, and emergency and routine child services. Generalised conclusions are tentative due to the heterogeneity and inconsistent quality of the included studies. Future research is recommended to define the pandemic's impact on women and children worldwide and prepare healthcare systems for future resurgences of COVID-19 and potential challenges beyond.

Systematic review registration

PROSPERO (CRD42021285178).